1. Pediatric Skin Disorders
There are disorders that occur to children at particular ages related to the growth and development process and the immaturity of the anatomical and physiological aspects of the child’s body. Nurse play an important role in public education and prevention.

2. Compare skin differences
Infant: skin not mature at birth
Adolescence: sebaceous glands become enlarged & active.
Infant- less effective barrier to physical elements & microorganisms thinner & more sensitive
Adolescence- They produce sebum in response to hormones ...predisposing to acne.

3. Skin Assessment Assess history Assess exposure Assess character
Assess sensation
Assess history of allergies, exposure to any irritants- chemicals, animals, medication, etc
Assess exposure to other people with similar complaints
Assess character for color, size, shape, distribution & lesion (macule, papule, bulla, etc)
Assess description of sensation- how it feels, if painful, pruritis

4. Dermatitis
Atopic/Eczema- worsens progressively, begins in early infancy genetic history of tendency for dry, sensitive skin, allergy and emotional stress. Family hx of asthma, hay fever, or atopic dermatitis. **Controversial role of immunoglobulin E ((IgE)- medicated food allergy has been shown to exacerbate condition in some children.
Contact Dermatitis- self limiting with removal of irritant and treatment with topical steroidal creams/ointments

5. Dermatitis
Inflammation of the skin that occurs in response to contact with an allergen or irritant; also referred to as “contact dermatitis”
Self limiting with removal of irritant and treatment with topical stseroidal creams/ointments

6. Dermatitis Common irritants:
Soap, fabric softeners, lotions, urine and stool
♦ Common allergens
poison ivy, poison oak
lanolin, latex, rubber
nickel, fragrances

7. Dermatitis: signs and symptoms
Erythema
Edema
Pruritus
Vesicles or bullae
that rupture, ooze and crust

8. Dermatitis: Treatment
Medications
Application of a corticosteroid topical agent: remind pt to continue use for 2-3 wks after signs of healing
Application of protective barrier ointments
Oatmeal baths, cool compresses
Antihistamines given for sedative effect
With children, clip fingernails….can lead to bacterial infections if they scratch

9. Eczema
Chronic superficial skin disorder characterized by intense pruritis

10. Eczema: signs and symptoms
Erythematous patches with vesicles
Pruritis
Exudate and crusts
Drying and scaling
Lichenification
(thickening of the skin)

11. Eczema, cont.

12. Goal of Treatment
Hydrate the skin

13. Treatment of Eczema Emollients (creams which lubricate the skin)
Oral antihistamines (control itching)
Antibiotics (treat superinfections)
Corticosteroids (anti-inflammatories)
Immunomodulators (inhibit T lymphocyte activation)
AVOID SOAPS!

14. Acne
Inflammatory disease of the skin, involving the sebaceous glands and hair follicles.
Contributing factors include: heredity, hormonal influences, and emotional stress (what a teenager eats may have little effect on the complexion)
Unrelated to cleanliness

15. Acne
Inflammatory disease of the skin involving the sebaceous glands and hair follicles.
Contributing factors include: heredity, hormonal influences and emotional stress

16. Acne: Three main types Follicular plugs Pustular papules
Cystic nodules

17. Patient teaching
Do not pick! This increases the bacterial count on the surface of the skin and opens lesions to infection which worsens scarring
Remind patients that the treatment will not show improvement until about 4-6 weeks but they must consistently follow the regime set up by the physician

18. Medical treatment for acne
Topical (Benzoyl peroxide, Tretinoin (RetinA), topical preferred to systemic; however, both may be needed
Oral: Tetracycline, minocycline, erythromycin; estrogen for female pts., Accutane
SE of Accutane: liver toxicity, teratogen; nosebleeds and depression.

19. Acne: Nursing care Avoid picking and squeezing
Use gentle skin cleansers
Avoid use of astringents containing ETOH
Avoid hats or abrasive rubbing of the skin
Wash hands after handling greasy foods
Limit use of petrolatum-based hair products; hair away from face
Use oil-free makeup, protections from windy, cold weather
Continue therapy even when improved

20. Impetigo Hemolytic Strep infection of the skin
Impetigo became infected
Hemolytic Strep infection of the skin
Incubation period is 2-5 days after contact
Strep infection of the skin- Test question

21. Begins as a reddish macular rash, commonly seen on face/extremities
Progresses to papular and vesicular rash that oozes and forms a moist, honey colored crust. Pruritis of skin
Common in 2-5 year age group
Spreads from one lesion to another; requires abx to treat

22. Therapeutic Management
Apply moist soaks of Burrow’s solution
Antibiotic therapy: Keflex for 10 days
Patient education
Burrow’s solution is aluminum acetate used as a drying agent for weeping skin lesions- to soften lesions, remove crusts, cover to prevent spread by itching
CUT FINGERNAILS
Topical antibiotic therapy TID Bactroban, Baciguent, Neosporin
Oral (systemic)- Cephalexin (Keflex) Erythromycin, Dicloxacillin ** Make sure the pt takes the entire regime of antibiotics– complication of impetigo and strep infections is glomerulonephritis
Teach thorough hand washing to patient and family (antibacterial soap), trim nails, wear gloves when treating the wounds, Teach family that child should not share towels, combs, eating utensils. Wash clothes and linens in machine using soap and hot water
Teach about transmission- wound to skin, protect immuno-compromised individuals.

23. Therapeutic Interventions for impetigo
Goal: prevent scarring and promote + self image.
Individualize treatment to gender, age, and severity of infection
Takes 4-6 wks to improve
What is the major nursing implication here?
To prevent spread of the lesions

24. Candiditis- Thrush Overgrowth of Candida albicans
Acquired through delivery
Candiditis is an overgrowth of the Candida albicans fungus- also known as Thrush or a yeast infection
Usually occurs during delivery when the NB passes through an infected vagina- candida is a common fungus found on the skin and is easily transmitted

25. Thrush Characterized by white patches in the mouth, gums, or tongue
Treated with oral Nystatin suspension: swish and swallow
May present as white film over tongue, or curd-like plaques on the tongue, gums, and buccal mucosa
Tell them apart from milk curds because they are difficult to remove (also may have foul breath- very unusual in an infant)
NB or child may have difficulty in eating (mouth hurts) or throat may be sore.
Diaper area– Candiditis dermatitis- will present as a bright read rash in the diaper area and may progress to the abdomen--- usually follows oral antibiotic therapy WHY?- antibiotics kill the normal flora and allow the yeast to take over
Diagnosis is upon assessment- may require a culture- but is so common that simple observation of the S&S is enough.

26. Dermatophytosis (Ringworm)
Tinea Capitis fungal
infection known as
“ringworm”
Transmission:
Person-to-person
Animal-to-person
Tinea Capitis- fungal infection of the stratum corneum, nails and hair (at the base of the hair, the hair may break off , usually grows back)
Why do cats have such a bad rep for spreading ring worm? Cats can get ringworm, they also dig in the moist soil and climb trees that may have the fungus. Sand boxes in playgrounds are one of the most common sources of infection

27. S&S:
Scaly, circumscribed patches to patchy, gray scaling areas of alopecia.
Pruritic
Generally asymptomatic, but severe, deep inflammatory reaction may appear as boggy, encrusted lesions (kerions)
Scaly, circumscribed patches to patchy, gray scaling areas of alopecia.
Pruritic
Generally asymptomatic, but severe, deep inflammatory reaction may appear as boggy, encrusted lesions (kerions)

29. Clinical manifestations
Fungal infection of the stratum corneum, nails and hair (the base of hair shaft causing hair to break off…rarely permanent)
Scaly, patches
Pruritis
Generally asymptomatic, but severe reactions may appear as encrusted lesions

30. Tinea: signs and symptoms

31. Therapeutic Interventions
Transmitted by clothing, bedding, combs and animals (cats especially)
May take 1-3 months to heal completely, even with treatment
Child doesn’t return to school until lesions dry

32. Diagnosis Potassium hydroxide examination Black Light
Potassium hydroxide examination- examine with microscope using potassium hydroxide to stain the fungus
Black light causes fungus to glow-phosphoresce

33. Medication Therapy Antifungals: Oral griseofulvin (Lamisil)
Give with fatty foods to aid in absorption
Treatment is 4-6 wks
Can return to daycare when lesions are dry
Oral- systemic treatment with oral griseofulvin (very bitter) Lamisil
Antifungal-topical on lesions until healed (may take 3 months)
Shampooing, short trimmed nails, hand washing, increase the effectiveness of treatment. Why is it best if the patient does not scratch??

34. Pediculosis Capitis (lice)
a parasitic skin disorder caused by lice
the lice lay eggs which look like white flecks, attached firmly to base of the hair shaft, causing intense pruritus
Lice require several meals of human blood daily, and will die if away from humans more than 2 days
Most common in children 3-10 years of age Why? Transmission via direct contact with someone infested

35. Diagnosis Direct identification of egg (nits)
Direct identification of live insects
Close examination of scalp reveals (nits) firmly attached to hair shafts
Easily transmitted by clothing, towels, combs, close contact, unrelated to hygiene

36. Pediculosis
Here you can see the nits (eggs) as well as the lice

37. Medication Therapy
Treatment: shampoos RID, NIX, Kwell(or Lindane) shampoo: is applied to wet hair to form a lather and rubbed in for at least amount of time recommended, followed by combing with a fine-tooth comb to remove any remaining nits.
Leave in place for 10 minutes and rise; towel dry; comb hair with a fine-ttoth comb to remove any remaining nits.

38. Scabies
Sarcoptes scabei mite.  Females are 0.3 to 0.4 mm long and 0.25 to 0.35 mm wide.  Males are slightly more than half that size.
A parasitic skin disorder (stratum corneum- not living tissue) caused by a female mite.
The mite burrows into the skin depositing eggs and fecal material; between fingers, toes, palms, axillae
pruritic & grayish-brown, thread-like lesion

39. Scabies between thumb and index finger
Scabies between thumb and index finger
On foot

40. Therapeutic Interventions
transmitted by clothing, towels, close contact
Diagnosis confirmed by demonstration from skin scrapings.
treatment: application of scabicide cream which is left on for a specific number of hours (4 to 14)to kill mite
rash and itch will continue until stratum corneum is replaced (2-3 weeks)

41. Care: Fresh laundered linen and underclothing should be used.
Contacts should be reduced until treatment is completed.